Diabetes

Question 1

What is MODY?

Answer 1

Maturity-onset diabetes of the young (type 2 picture in a young person)

Question 2

What is LADA?

At what age does it most commonly present?

Answer 2

Late + autoimmune diabetes of adulthood (autoimmune destruction of pancreas, but happens at a slower rate than in DM1)
Late 20s

Question 3

What are RFs for gestational diabetes?

Answer 3

History in a previous pregnancy, FH, obesity, Afro-Caribbean , Asian, previous large baby or still birth (may have had gestational diabetes then)

Question 4

What does gestational diabetes predispose women to?

Answer 4

DM2 in later life

Question 5

What is the pathophysiology of DKA?

Answer 5

excessive glucose but a lack of insulin, so it can’t be taken into cells to metabolise. The body is pushed into a starvation-like state where ketoacidosis is the only mechanism of energy production

Question 6

How may DKA present?

Answer 6

Ketotic (sweet-smelling) breath. Generalised abdo pain, N+V, hyperventilation, reduced consciousness, Kussmaul breathing

Question 7

What is Kussmaul breathing?

Answer 7

Deep + laboured breathing

Question 8

How is DKA diagnosed? (3 things)

Answer 8

1. Diabetic: blood glucose >11
2. Ketones: >3 or urinary >2
3. Acidotic: pH <7.3 or bicarb <15

Question 9

How is DKA managed?

Answer 9

IV insulin + dextrose

Fluids: 1 L 0.9% saline over 1 hour

Question 10

What should be done in DKA if systolic BP is <90?

Answer 10

Bolus 500ml saline over 15 minutes, then give

Question 11

What is HHS (Hyperosmotic Hyperglycaemic state)

3 parts

Answer 11

Hypovolaemic
Marked hyperglycaemia >30mmol/L
Osmolality >30

Question 12

What is HHS usually precipitated by?

Answer 12

Another illness

Question 13

How do you manage HHS?

Answer 13

Fluid resus (IV 0.9% saline over 1 hour)
Aiming for a positive balance by 2-3 L over 6 hours

Question 14

How many tests are needed to diagnose DM?

Answer 14

1 - if patient is symptomatic

2 - if asymptomatic (2 + results on 2 separate occasions)

Question 15

What test is used for diagnosis of gestational diabetes?

Answer 15

OGTT

Question 16

What happens in OGTT?

Answer 16

Patient is given a sugary drink and blood glucose is measured before, then at intervals after. Must fast for >8 hours before. Notable values are before the drink and 2 hours after

Question 17

What are the values for diagnoses of gestational diabetes? (think 5678)

Answer 17

Fasting sample >5.6 + 2 hour sample >7.8

Question 18

What are the values for diagnosis of diabetes (fasting, random glucose and HbA1c)

Answer 18

Fasting >7
Random >11
HbA1c >48

Question 19

What are the HbA1c values for pre-diabetes?

Answer 19

42-47

Question 20

Why is HbA1c generally preferred for diagnosis of DM2?

Why not for DM1?

Answer 20

Measures blood glucose control over past 3 months

Someone presenting with DM1 may not have had the condition for long enough

Question 21

What type of sample is needed to diagnose DM2?

Answer 21

A venous sample

Question 22

New diagnosis: what is the management for someone with a HbA1c of 48?

Answer 22

3-6 months of lifestyle advice

Or start monotherapy

Question 23

When should you add a second drug?

Answer 23

If HbA1c >53

Question 24

When should you add a third drug?

Answer 24

HbA1c >58

Question 25

What is the target HbA1c for someone on triple therapy?

Answer 25

HbA1c target of 53